Date of Graduation

2007

Document Type

Dissertation/Thesis

Abstract

Confidentiality is at the cornerstone of what can make or break the therapeutic relationship. Ethical guidelines are constantly changing, and therapists need to consider their ethical code and other variables including their state law and organizational policy when making decisions related to confidentiality. When working with clients of varying developmental levels, the decisions therapists make regarding confidentiality issues are often not clear. In addition, therapists’ views and experiences concerning confidentiality can play a large role in their decisions concerning obtaining informed consent, duty to protect, and breaching confidentiality in therapy. This exploratory study examined the differences among therapists of diverse professional associations, work settings, and personal characteristics with regard to their beliefs, experiences, and behaviors in managing confidentiality with clients of various age ranges. A survey instrument was adapted from previous surveys of Miller (2002), Mannarino (1982), and Sullivan et. al.(2002) examining child abuse and confidentiality. A pilot study was conducted and changes were made based on participant feedback. A randomized sample of 200 members from the American Psychological Association, 100 members from the American Mental Health Counselors Association and 100 members from the American School Counselor Association were obtained for participation in the study. One hundred and fourteen usable surveys were returned after a follow-up notice was sent to members of the professional organizations. Data analyses revealed statistically significant differences across professional organization, work setting, and therapist personal characteristics (years of post-graduate clinical experience, graduate degree, primary theoretical orientation, age). More specifically, differences were noted concerning ways of obtaining consent for therapy/assessment, approach to discussing confidentiality in therapy/assessment, information shared/provided to parents/guardians, ways of managing client risk taking behaviors, and the influence of specific factors on the management of client confidentiality. This research study was also designed to explore the differences in which various professionals handled confidentiality-related issues with clients of diverse age ranges. As expected, in a variety of situations, client age was found to impact therapists’ confidentiality-related decisions. Clinical implications and limitations are discussed as well as suggestions for future research.

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